Endless Wanting: A Tale of Wile E. Coyote

Wile-E-Coyote-Surgeon-GeneralAnd, here’s what you missed…

  • Healthcare is continuously evolving.
  • We are on a mission to margin; rising costs are unsustainable.
  • There is little room for error; hospitals are at risk of closing, and demand for health services already exceeds supply.
  • Reviewing economic indicators, industry trends, and our own financial solvency, effectiveness and profitability regularly will inform our decisions with needed perspective.
  • There is no silver-bullet, or single solution, however elaborate, to transform this accidental wasteland. We all have a role to play in fixing it.

Endless Wanting: A Tale of Wile E. Coyote

Hopefully, at some point in your life, you’ve enjoyed a hearty belly-laugh at the expense of The Road Runner and Wile E. Coyote’s antics. If not, I encourage you to indulge in a little cartoon break.

Chariots of Fur – The Road Runner

What you may not know is that, Chuck Jones, the creator of The Road Runner, based Wile E. Coyote on a character from Mark Twain’s early memoirs, Roughing It. In the book, Twain describes his coyote as “a living, breathing allegory of Want. He is always hungry.”

You and I have a lot in common Wile E. Coyote.

What I mean by that is, in our health care model, where supply and demand are imbalanced, both sides (providers and consumers) are left feeling unhappy. We’re left wanting. And so, sometimes we act, well a bit like Wile E., going to extreme measures in pursuit of our goal.

Too bad it hasn’t worked, yet.

I could also crack some jokes about how Wile E. (like us) is typically attempting some version of the same, basic strategy: “Blow up The Road Runner” or “Catch The Road Runner” This time, though, he’s given it a new name, or a creative twist… RHIOs.. data marts…registries… remote data centers… clouds… ACOs… PCMH.. data exchange… interoperability… pay-for-performance… VBC…

And thinks it will change his outcome… Hah!

I mean, it’s the definition of insanity!

(Sigh.) That Road Runner can be so elusive.

Are you tracking with me on this crazy analogy? Did you figure out that the Road Runner represents sustainable health? Always running around with his healthy lifestyle? Doing his happy “beep beep” Road Runner thing? Smiling and confident?

(Clearly HE has access to behavioral health services I don’t…)

Look, the point is that The Road Runner is FAST and he gets further from us the longer we wait. If we want to catch him, and leave this constant state of wanting, let’s focus on OUR environment. Let’s try something different.

Let’s get specific about what WE need.

Let me reiterate: there is no ACME silver bullet.

Instead, our goal is to maintain the delicate balance of three, interdependent forces as we make the shift to sustainable health: Speed to Value (costs), Speed to Market (commercial), and Speed to Trust (culture).

They are how we achieve supply and demand equilibrium.

If we don’t stay balanced, if we get carried away and chase one too quickly, we run the risk of falling off the cliff with Mr. Coyote.

And, do coyotes have nine lives? (Sorry, I couldn’t help myself..)

Speed To Value

Speed to Value is our ability to deliver better outcomes for lower costs.

Yes, that means A LOT of the solutions you’re hearing about in the marketplace fall into this category (ACO, PCMH, etc). They claim that with the help of their software, or care model, or hardware: YOU will be able to reduce the use of expensive human capital with technology, or enable your staff to accomplish more (better outcomes) with fewer resources.

And they might be right, but be sure you understand your organization’s unique requirements before investing in any particular strategy to improve value (outcomes/costs). Know where your waste is.

Remember the questions you left with after the review of your frightening financial monsters (solvency, effectiveness and profitability)? What are your unique strengths? Challenges?

On a macro-level, reform has served as a catalyst to accelerate a market trend towards value-based care and pay-for-performance business models for providers and care delivery networks.

Providers aren’t the only ones changing to meet market demands.

Take the insurance industry, as an example.  Plan designs are highlighting “what they expect” and “how they will pay” going forward. To this end, revenue from fee-for-service transactional medicine will materially decrease over the next 18-24 months. Do you know what changes the payers in your community have planned? Are you working together? What are your constraints?

Employers are affected as well. Employee wellness and productivity will be the counterbalance to premium increases. Employers will hold themselves and their employees accountable for the cost and value of care. These changes will have a significant ripple effect on margin for their business, especially as the Cadillac Tax takes effect in 2018. Do you know what your community’s employers have planned? Are you working together? What are your constraints?

What other ways can we introduce shared risk, shared responsibility and shared reward in our community, to lower costs and improve outcomes?

The velocity by which these kinds of changes occur is called Speed To Value. Those ready will be positioned to capitalize.

Speed To Market

For those selling to any organization managing a population of people, which is all of them, there is an immediate opportunity to retool prospecting, business development, and account management activities to align with this dynamic. This go-to-market effort is called Speed to Market.

This includes efforts to improve physician loyalty (referrals), employer preference (direct contracting), and finding creative ways to expand your presence in your community and with consumers.

You need to be everywhere your consumers are!

Speed To Trust

While often overlooked, Speed to Trust represents an ability to motivate organizations and consumers to evaluate the cultural changes necessary to empower healthy, productive populations. This includes: setting new expectations for health plans, new partnership models with employers, supporting and motivating healthy choices, creating measurable metrics for health value, and intentionally nurturing the confidence of our constituents, among others…

Changing payment incentives will scrutinize and encourage specific consumer behaviors, like Flo from Progressive offering to give you a discount for safe driving.

Yet, to earn the right to influence personal choice, organizations must create engaging experiences, offer education, and in some cases relinquish control. Moving too far in either direction (micromanaging or leaving consumers to his/her own [de]vices) poses a challenge to perceived sincerity and sustainability of the effort.

Key takeaway:  You will need to address commercial (Speed to Market), cost (Speed to Value) and cultural (Speed to Trust) strategies to balance supply and demand (and feed Wile).

Your plan for 2016 and beyond won’t come from ACME, if you want to catch The Road Runner.

Next time: What does this all mean for our strategic plan? How do we connect these ideas with our organization’s goals, strategies, processes, initiatives and solutions?

…That’s All Folks!


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